Application for Employment

Application for Employment

 


 


 

Present address




Former address





 


Full timePart timeTempSeasonal

 

 


 
YesNo

YesNo



YesNo 		 
YesNo

YesNo 		 
YesNo

YesNo
YesNo

YesNo

 

Education Name and location Of School # of years Completed Did you Graduate? Subjects Studied
Academic Currently Attending
Last Completed
Trades of

Business		 Currently Attending
Last Completed

Employment Application

Date Month and Year Name and address of employer Salary Job Reason for Leaving

References: Give the names of three persons not related to you to whom you have known at least 1 year
Name Address Phone Yrs acquainted

List any foreign language(s) and check the box that best describes your skill level.
Language Read and write Read and speak Speak only
In case of Emergency notify




INITIAL

Conditions of Employment – please read carefully
  • Reporting to work with impaired abilities; or the possession, consumption or
    distribution of drugs or alcohol on company premises and/or worksites, shall be grounds
    for disciplinary action, including discharge. A condition of employment includes
    willingness on the part of the applicant or employee to agree to physical examination,
    polygraph and/or substance testing, if required by the company. We are committed to
    operating a drug free workplace. Violations of our drug and alcohol policy will result in
    dismissal.

  • It is understood and agreed upon that any misrepresentation by me in this
    application will be sufficient cause for cancellation of this application and/or separation
    from the employer’s service, if I have been employed. Furthermore, I understand that
    just as I am free to resign anytime, the Employer reserves the right to terminate my
    employment at any time, with or without cause and without prior notice. I understand
    that no representative of the Employer has the authority to make any assurances to the
    contrary.

  • I give the employer the right to investigate all police, driving, and personal records
    and references, if job related. I hereby release from liability the Employer and its
    representatives for seeking such information and all other persons, corporations or
    organizations for furnishing such information.

  • The Employer is an Equal Opportunity Employer. The Employer does not
    discriminate in employment and no question on this application is used for the purpose of
    limiting or excusing any applicant’s consideration for employment on a basis prohibited
    by local, state or federal law.

  • Any controversy of any kind arising between the parties under this agreement or
    otherwise (or any agent, officer, director or affiliate of any party), including but not
    limited to common law, statutory, tort or contract claims, will be submitted to mediation,
    and failing settlement in mediation, to binding arbitration. Unless otherwise agreed, a
    mediation and arbitration designated by staff professionals will govern any mediation and
    arbitration. The parties will select the mediator or arbitrator from the designated
    company. Panel of mediators and will notify the designated company, in writing, to initiate the
    selection process. The arbitration will be subject to and governed by the provisions of the
    Federal Arbitration Act. 9 U.S.C. Section 1-et seq. The parties hereto stipulate that this
    agreement involves matters affecting interstate commerce.

  • This application is current for 60 days. At the conclusion of this time, if I have not
    heard from the Employer and still wish to be considered for employment, it will be
    necessary to fill out a new application.

 

AGENCY MANAGEMENT NOTES :